Essentials of Understanding Abnormal Behavior Chapter Fourteen

1
Essentials of Understanding Abnormal
BehaviorChapter Fourteen

• Eating Disorders

2
Types of Eating Disorders

• Anorexia nervosa
• Bulimia nervosa
• Binge-eating disorder
• Eating disorder not otherwise specified

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Eating Disorders

• 13.4 of girls and 7.1 of boys engage in
  disordered eating patterns.
• Paradox As emphasis on thinness is increasing,
  so is the problem of obesity
• 7 million women and 1 million men in the U.S.
  suffer from eating disorders.
• 15 of young women have substantially
  disordered eating attitudes and behaviors.

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Factors Associated with Disordered Eating Patterns

• Being overweight
• Low self-esteem
• Depression
• Substance use
• Suicidal ideation
• More prevalent among females
• Least likely among African American females

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Table 16.1 Prevalence of Weight Concerns of
Youth in Grades 5-12
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Figure 16.1 Disorders Chart Eating Disorders
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Figure 16.1 Disorders Chart Eating Disorders
(contd)
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Anorexia Nervosa

• Eating disorder characterized by
• Refusal to maintain a body weight above the
  minimum normal weight for a persons age and
  height
• Intense fear of becoming obese that does not
  diminish with weight loss
• Body image distortion
• In females, absence of at least 3 consecutive
  menstrual cycles otherwise expected to occur

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Table 16.2 Do You Have an Eating Disorder?
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Anorexia Nervosa (contd)

• Subtypes
• Restricting Lose weight through dieting or
  exercising
• Binge-eating/purging Lose weight through use of
  self-induced vomiting, laxatives, or diuretics

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Anorexia Nervosa (contd)

• Physical complications
• Cardiac arrhythmia, low blood pressure, slow
  heart rate, weakened heart muscle
• Lethargy, dry skin, brittle hair, swollen parotid
  glands, hypothermia
• Males Osteoporosis, substance use disorder,
  antisocial personality disorder
• Associated characteristics
• Obsessive-compulsive behaviors and thoughts
• Control

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Anorexia Nervosa (contd)

• Associated characteristics (contd)
• Personality disorders/characteristics
• Restricting introversion, conformity,
  perfectionism, rigidity
• Binge eating/purging Extroverted, histrionic,
  emotionally volatile, impulse control problems,
  substance abuse

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Anorexia Nervosa (contd)

• Course and outcome Highly variable
• Usually begins in adolescence
• Better outcome for binge-eating/purging
• More severe is associated with constricted/
  overcontrolled profile
• 44 recover completely, 28 show some weight
  gain but remain underweight, poor outcome for
  24
• Death 5-20, primarily from cardiac arrest or
  suicide

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Bulimia Nervosa

• Eating disorder characterized by
• Recurrent episodes of binge eating (rapid
  consumption of large quantities of food) at least
  twice a week for 3 months, during which the
  person loses control over eating and uses
  vomiting, laxatives, and excess exercise to
  control weight
• More psychopathology than non-bulimics Greater
  external locus of control, lower self-esteem and
  sense of personal effectiveness, negative
  self-image, although most are within normal
  weight range

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Bulimia Nervosa (contd)

• More prevalent than anorexia
• Up to 3 of women suffer from bulimia, another
  10 report some symptoms
• 10 of bulimics are male
• Physical complications
• Effects of vomiting Erosion of tooth enamel,
  dehydration, swollen parotid glands, low
  potassium (can weaken heart and cause arrhythmia
  and cardiac arrest)
• Binge eating may cause stomach ruptures
• Gastrointestinal disturbances

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Bulimia Nervosa (contd)

• Related to
• Coping responses to stress
• Mood disorders, especially seasonal affective
  disorder
• Also shares characteristics of borderline
  personality

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Bulimia Nervosa (contd)

• Course and outcome
• Generally begins late adolescence/early adulthood
• Mixed, but better course than for anorexia
• Some bulimics continue to show disturbed eating
  patterns, low self-esteem, depressive disorder,
  but most recover either fully or partially
• Poorer prognosis with associated history of
  substance use and longer duration before treatment

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Binge-Eating Disorder (BED)

• Diagnostic category provided for further study
  in DSM-IV-TR
• Involves a large consumption of food over a short
  period of time at least twice weekly for 6 months
• Unlike bulimia, does not involve use of extreme
  behavioral attempts of vomiting, fasting, or
  excessive exercise as compensation for binge
  eating
• Diagnosis History of binge-eating episodes at
  least 2 days/week for 6 months

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Binge-Eating Disorder (contd)

• Prevalence
• Prevalence 0.7-4 of population
• Females are 1.5 times as likely as males to have
  the disorder.
• Prevalent among white, African American, and
  American Indian women (possibly 10), although
  white women are more likely to be seen for the
  disorder

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Binge-Eating Disorder (contd)

• Associated characteristics/risk factors
• Overweight with history of weight fluctuation
• Prevalence 2-5
• Adverse childhood experiences, parental
  depression, vulnerability to obesity, repeated
  negative comments re weight and body
• Binges preceded by poor mood, low alertness,
  feelings of poor eating control, cravings for
  sweets
• Complications High blood pressure, high
  cholesterol, diabetes, and depression

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Binge-Eating Disorder (contd)

• Comorbid features
• Major depressive disorder
• Obsessive-compulsive personality disorder
• Avoidant personality disorder
• Course and outcome
• Begins in late adolescence/early adulthood
• Positive course compared with other eating
  disorders Most recover within 5 years
• Weight remains high (over time, 1/3 meet
  criteria for obesity)

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Eating Disorder Not Otherwise Specified

• DSM-IV-TR Eating disorders not meeting criteria
  for anorexia or bulimia nervosa
• Individuals with binge-eating disorder
• Female who meets criteria for anorexia but has
  regular menses
• Individual who has lost significant weight but is
  in normal weight range

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Eating Disorder Not Otherwise Specified (contd)

• DSM-IV-TR Eating disorders not meeting criteria
  for anorexia or bulimia nervosa (contd)
• Individual engaging in binge eating and
  compensatory activities less than twice a week or
  less than 3 months
• Normal weight individual who uses compensatory
  behaviors after eating, or who chews or spits out
  food without ingesting

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Table 16.3 Overview of Major Risk Factors for
Eating Disorders
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Etiology of Eating Disorders

• Societal influences
• Mass media portray ideal female body as 57 110
  lbs actual average is 54 162 lbs
• Sociocultural demand for thinness
• Peer influences
• Criticisms by family members about weight
• Dating

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Etiology of Eating Disorders (contd)

• Body dissatisfaction
• Males see their bodies as smaller than what they
  believe is preferred females see their bodies as
  larger than what they believe is preferred
• Most dissatisfaction parallels low self-esteem
• Certain predisposition and characteristics lead
  some people to interpret images of thinness as
  evidence of their own inadequacy

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Etiology of Eating Disorders (contd)

• Exposure to ultra-thin ideal by media can lead
  to
• Internalization of that image and eating patterns
  intended to bring about that ideal
• Negative affect, which triggers dieting
• Social comparison, which leads to disordered
  eating to meet external standards of comparison

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Figure 16.4 Route to Eating Disorders
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Etiology of Eating Disorders (contd)

• Family and peer influences
• Psychodynamic (for anorexia)
• Fear of maturation
• Growing up and separating from family
• Developing own identity
• Fulfills unconscious desire to remain a child
• Family systems Problematic family communication
  patterns result in anorexia

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Etiology of Eating Disorders (contd)

• Family and peer influences (contd)
• Socialization agents (peers and family)
• Relationship problems and role models

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Etiology of Eating Disorders (contd)

• Cultural factors
• Culture-bound (Western cultures) and other
  societies influenced by Western culture
• Many African Americans seem insulated from
  thinness standard, but equally as likely to have
  binge-eating disorder
• Internalization of U.S. societal values regarding
  attractiveness affects self-esteem and body
  dissatisfaction.

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Table 16.5 Differences in Body Image and Weight
Concerns Among African American and White Females
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Other Etiological Factors

• Personality characteristics and negative
  emotional moods
• Sexual abuse
• Low self-esteem and feelings of helplessness
• Passivity, dependence, nonassertivness
• Anorexia Perfectionism, obedience, academic and
  athletic success, model children
• Bulimia Perfectionism, seasonal affective
  disorder
• Genetic factors First-degree relatives

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Treatment of Eating Disorders

• Prevention programs
• Goals of school-based intervention program
• Develop positive attitude toward ones body
• Become aware of societal messages re being female
• Develop healthier eating/exercise habits
• Increase comfort in expressing feelings
• Develop healthy strategies to deal with stress
• Increase assertiveness skills

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Treatment of Eating Disorders (contd)

• Prevention programs (contd)
• Teach females to examine consequences of gender
  messages
• Institutional awareness of the problem is
  critical

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Treatment of Eating Disorders (contd)

• Anorexia nervosa
• Inpatient/outpatient depends on weight and health
  of individual
• Initial goal Restore weight with psychological
  support
• Nutritional/physical rehabilitation
• Identify/understand dysfunctional attitudes
• Improve interpersonal/social functioning
• Address comorbid psychopathology/psychological
  conflicts

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Treatment of Eating Disorders (contd)

• Anorexia nervosa (contd)
• Family therapy Parents involved in meal
  planning, reduce criticism (understanding
  seriousness of anorexia), negotiate new
  relationship patterns, move toward separation and
  individuation

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Treatment of Eating Disorders (contd)

• Bulimia nervosa
• Identify conditions contributing to purging
• Identify physical conditions resulting from
  purging
• Normalize eating pattern and eliminate
  binge-purge cycle

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Treatment of Eating Disorders (contd)

• Bulimia nervosa (contd)
• Cognitive-behavioral therapy and use of
  antidepressants
• Encourage eating 3 or more balanced meals a day
• Reduce rigid food rules and body image concerns
• Develop cognitive and behavioral strategies

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Treatment of Eating Disorders (contd)

• Binge-Eating Disorder
• Similar to treatments for bulimia with fewer
  physical complications
• Because most are overweight, therapy programs try
  to help individual lose weight
• Three phases
• Determine underlying cognitive factors
• Use cognitive strategies to change distorted
  beliefs about eating
• Relapse prevention strategies